How to do chest compressions: emergency resuscitation in case of cardiac arrest. Indirect cardiac massage and artificial respiration - rules and techniques for its implementation

Poisoning with certain substances can cause respiratory and cardiac arrest. In such a situation, the victim needs help immediately. But there may be no doctors nearby, and an ambulance may not arrive in 5 minutes. Every person should know and be able to apply in practice at least basic resuscitation measures. These include artificial respiration and external cardiac massage. Most people probably know what it is, but do not always know how to correctly perform these actions in practice.

Let's find out in this article what kind of poisoning can cause clinical death, what kind of human resuscitation techniques exist, and how to properly perform artificial respiration and chest compressions.

What kind of poisoning can cause breathing and heartbeat to stop?

Death as a result of acute poisoning can happen from anything. The main causes of death in case of poisoning are cessation of breathing and heartbeat.

Arrhythmia, atrial and ventricular fibrillation and cardiac arrest can be caused by:

In what cases is artificial respiration necessary? Respiratory arrest occurs due to poisoning:

In the absence of breathing or heartbeat, clinical death occurs. It can last from 3 to 6 minutes, during which there is a chance of saving the person if you start artificial respiration and chest compressions. After 6 minutes, it is still possible to bring a person back to life, but as a result of severe hypoxia, the brain undergoes irreversible organic changes.

When to start resuscitation measures

What to do if a person falls unconscious? First you need to identify signs of life. The heartbeat can be heard by placing your ear to the victim's chest or by feeling the pulse in the carotid arteries. Breathing can be detected by the movement of the chest, leaning towards the face and listening for inhalation and exhalation by holding a mirror to the victim’s nose or mouth (it will fog up when breathing).

If no breathing or heartbeat is detected, resuscitation should begin immediately.

How to do artificial respiration and chest compressions? What methods exist? The most common, accessible to everyone and effective:

external cardiac massage;
mouth-to-mouth breathing;
breathing "from mouth to nose".

It is advisable to conduct receptions for two people. Cardiac massage is always carried out together with artificial ventilation.

Procedure in the absence of signs of life

Free the respiratory organs (oral, nasal cavity, pharynx) from possible foreign bodies.
If there is a heartbeat, but the person is not breathing, only artificial respiration is performed.
If there is no heartbeat, artificial respiration and chest compressions are performed.

How to do indirect cardiac massage

The technique of performing indirect cardiac massage is simple, but requires the right actions.

Why is indirect cardiac massage impossible if the victim is lying on something soft? In this case, the pressure will be released not on the heart, but on the pliable surface.

Very often, ribs are broken during chest compressions. There is no need to be afraid of this, the main thing is to revive the person, and the ribs will grow together. But you need to take into account that broken ribs are most likely the result of incorrect execution and you should moderate the pressing force.

Age of the victim	How to press	Pressing point	Depth of pressing	Velocity	Inhalation/pressure ratio
Age up to 1 year	2 fingers	1 finger below the nipple line	1.5–2 cm	120 and more	2/15
Ages 1–8 years		2 fingers from the sternum		100–120
Adult	2 hands	2 fingers from the sternum	5–6 cm	60–100	2/30

Artificial respiration from mouth to mouth

If a poisoned person has secretions in the mouth that are dangerous for the resuscitator, such as poison, poisonous gas from the lungs, or an infection, then artificial respiration is not necessary! In this case, you need to limit yourself to performing an indirect cardiac massage, during which, due to pressure on the sternum, about 500 ml of air is expelled and again absorbed.

How to do mouth-to-mouth artificial respiration?

For your own safety, it is recommended that artificial respiration is best done through a napkin, while controlling the tightness of the pressure and preventing air “leakage”. Exhalation should not be sharp. Only strong but smooth (for 1–1.5 seconds) exhalation will ensure proper movement of the diaphragm and filling of the lungs with air.

Artificial respiration from mouth to nose

Artificial respiration “mouth to nose” is performed if the patient is unable to open his mouth (for example, due to a spasm).

Having laid the victim on a straight surface, tilt his head back (if there are no contraindications for this).
Check the patency of the nasal passages.
If possible, the jaw should be extended.
After a maximum inhalation, you need to blow air into the injured person’s nose, tightly covering his mouth with one hand.
After one breath, count to 4 and take the next one.

Features of resuscitation in children

In children, resuscitation techniques differ from those in adults. The chest of babies under one year old is very tender and fragile, the heart area is smaller than the base of the palm of an adult, so pressure during indirect cardiac massage is performed not with the palms, but with two fingers. The movement of the chest should be no more than 1.5–2 cm. The frequency of compressions is at least 100 per minute. From 1 to 8 years of age, massage is done with one palm. The chest should move 2.5–3.5 cm. Massage should be performed at a frequency of about 100 pressures per minute. The ratio of inhalation to compression on the chest in children under 8 years old should be 2/15, in children over 8 years old - 1/15.

How to perform artificial respiration for a child? For children, artificial respiration can be performed using the mouth-to-mouth technique. Since babies have small faces, an adult can perform artificial respiration by immediately covering both the child’s mouth and nose. The method is then called “mouth to mouth and nose.” Artificial respiration is given to children at a frequency of 18–24 per minute.

How to determine if resuscitation is being performed correctly

Signs of effectiveness when following the rules for performing artificial respiration are as follows.

The effectiveness of cardiac massage also needs to be checked every minute.

If, when performing an indirect cardiac massage, a push appears on the carotid artery, similar to a pulse, then the pressing force is sufficient for blood to flow to the brain.
If resuscitation measures are performed correctly, the victim will soon experience heart contractions, blood pressure will rise, spontaneous breathing will appear, the skin will become less pale, and the pupils will narrow.

All actions must be completed for at least 10 minutes, or better yet, before the ambulance arrives. If the heartbeat persists, artificial respiration must be performed for a long time, up to 1.5 hours.

If resuscitation measures are ineffective within 25 minutes, the victim has cadaveric spots, a symptom of a “cat” pupil (when pressure is applied to the eyeball, the pupil becomes vertical, like a cat’s) or the first signs of rigor - all actions can be stopped, since biological death has occurred.

The sooner resuscitation is started, the greater the likelihood of a person returning to life. Their correct implementation will help not only restore life, but also provide oxygen to vital organs, prevent their death and disability of the victim.

Clinical death is a condition in which the human body lacks heartbeat and respiratory functions, but irreversible processes have not yet begun. During this period, correctly carried out resuscitation actions can save a human life, so each of us should know what indirect cardiac massage is (technique). Quite often, cardiac arrest is caused by pathologies such as stroke, heart attack, thrombosis, hemorrhage and other diseases associated with the functioning of the cardiovascular system and brain. Providing first aid is the duty of every conscientious person, and it must be carried out in accordance with medical standards. Therefore, below we will consider a step-by-step technique for performing chest compressions, and will also tell you how to perform artificial ventilation.

Let's turn to physiology: what happens after the heart stops

Before we figure out how to properly perform artificial respiration and cardiac massage, let’s turn to human physiology and consider how the heart and vascular system work, and what are the consequences of stopping blood flow in the body.

The human heart has a four-chamber structure and consists of two atria and two ventricles. Thanks to the atria, blood enters the ventricles, which, during systole, push it back into the pulmonary and systemic circulation to distribute oxygen and nutrients throughout the body.

The work of blood is as follows:

blood flow: passing through a large circle of blood flow, it carries vital substances for cells, while taking away decay products from them, which are then excreted from the body through the kidneys, lungs and skin;
the task of the small circle of blood flow is to replace carbon dioxide with oxygen; this exchange occurs in the lungs during inhalation and exhalation.

When the heart stops, blood stops flowing through the arteries, veins and vessels. The entire process described above stops. Decay products accumulate in the cells, and the lack of respiration leads to the saturation of the blood exclusively with carbon dioxide. Metabolism stops and cells die as a result of “intoxication” and lack of oxygen. For example, to kill brain cells, it is enough to stop the blood flow for up to 3-4 minutes; in exceptional cases, this period is slightly increased. Therefore, it is so important to carry out resuscitation actions for the first time minutes after the heart muscles stop working.

Indirect cardiac massage: technique

To perform an indirect cardiac massage, you need to place one hand (palm down) on 1/3 of the lower part of the sternum. The main center of pressure should be on the metacarpus. Place your other palm on top. The main condition is that both hands must be kept straight, then the pressure will be rhythmic with equal force. The optimal force is considered to be when the sternum drops 3–4 cm during chest compressions.

What happens in the body during resuscitation? When exposed to the chest, the chambers of the heart are compressed, while the interchamber valves open, and blood penetrates from the atria into the ventricles. The mechanical effect on the heart muscles helps push blood into the vessels, which prevents the blood flow from stopping completely. If the actions are synchronous, then the heart’s own electrical impulse is activated, thanks to which the heart “starts” and blood flow is restored.

Rules for conducting resuscitation massage

Before performing indirect cardiac massage, it is necessary to find out whether there is a pulse, as well as respiratory processes. If they are absent, a number of mandatory actions should be performed before starting cardiac massage and ventilation.

Place the person straight, preferably on a flat, hard surface.
Loosen clothing and determine the pressure point.
Kneel next to him on the side that is comfortable for you.
Clear the airways of possible vomit, mucus, and foreign objects.
An adult is given a heart massage with two hands, a child with one, and an infant with two fingers.
Repeated pressure is applied only after the sternum has completely returned to its original position.
The norm is considered to be 30 impacts on the chest, per 2 breaths, this is justified by the fact that when impacting the sternum, passive inhalations and exhalations occur.

How to resuscitate a victim: the actions of one person

One person can perform indirect cardiac massage and artificial respiration himself. Initially, the “preparatory” actions described above are performed, after which the execution technique algorithm should be as follows:

Initially, two air injections are made, each lasting 1–2 seconds. After the first blowing, you need to make sure that the chest drops (the air comes out) and only then make the second blow. It can be done by blowing through the mouth or nose. If artificial ventilation of the lungs is carried out through the mouth, then the nose is pinched with the hand, if through the nose, then the mouth is secured with the hand. In order to protect yourself from the possibility of pathogenic microflora entering your body, you need to inflate through a napkin or handkerchief.
After the second injection of air, begin chest compressions. Your arms should be straight, their correct position is described above. Controlling the strength, apply 15 pressures.
Repeat the steps from the beginning. Resuscitation should continue until emergency assistance arrives. If 30 minutes have passed since the person began to “revive”, and no signs of life (pulse, breathing) have appeared, then biological death is declared.

If indirect cardiac massage and artificial respiration are performed by 1 person, the frequency of effects on the chest should normally be about 80–100 compressions per minute.

How should a victim be resuscitated? Actions of two people

If indirect cardiac massage and artificial respiration are performed by 2 people, then the algorithm and technique are different. Firstly, it is much easier for two people to perform resuscitation, and secondly, each of those providing assistance is responsible for a separate process, cardiac massage or ventilation of the lungs. The technique for performing resuscitation is as follows:

The person performing artificial respiration kneels at the head of the victim.
The person responsible for the process of indirect massage places the hands on the patient’s sternum.
Initially, two injections are made into the mouth or nose.
Afterwards, two impacts on the sternum.
Insufflations are repeated again after pressing.

The normal frequency of compressions during resuscitation by two people is about 80 times per minute.

Features of children's resuscitation

The main differences (features) of resuscitation in children are as follows:

using only one pussy or only two fingers;
the frequency of pressure for infants should be about 100 times per minute;
the depth of breast descent during compression is no more than 1–2 cm;
During resuscitation, children are given air blowing through the oral cavity and through the nasal canals, the frequency of blowing is about 35–40 times per minute;
Since the volume of the child’s lungs is small, the air blown in should not exceed the volume that can be accommodated in the resuscitator’s mouth.

Remember that you can bring a person back to life only for the first few minutes after cardiac arrest, so do not hesitate, but immediately begin resuscitation actions.

When restoring breathing and cardiac activity of an unconscious victim, must be laid on its side to prevent him from suffocating with his own sunken tongue or vomit.

The retraction of the tongue is often indicated by breathing that resembles snoring and severe difficulty in inhaling.

Rules and techniques for performing artificial respiration and chest compressions

If p Animation measures are carried out by two people, one of them performs cardiac massage, the other performs artificial respiration in the mode of one insufflation every five presses on the chest wall.

When to start resuscitation measures

If no breathing or heartbeat is detected, resuscitation should begin immediately.

How to do artificial respiration and chest compressions? What methods exist? The most common, accessible to everyone and effective:

external cardiac massage;
mouth-to-mouth breathing;
breathing "from mouth to nose".

It is advisable to conduct receptions for two people. Cardiac massage is always carried out together with artificial ventilation.

Procedure in the absence of signs of life

Free the respiratory organs (oral, nasal cavity, pharynx) from possible foreign bodies.
If there is a heartbeat, but the person is not breathing, only artificial respiration is performed.
If there is no heartbeat, artificial respiration and chest compressions are performed.

How to do indirect cardiac massage

The technique of performing indirect cardiac massage is simple, but requires the right actions.

1. The person is laid on a hard surface, the upper body is freed from clothing.

2. To perform closed cardiac massage, the resuscitator kneels on the side of the victim.

3. The palm, with its base extended as far as possible, is placed in the middle of the chest, two to three centimeters above the sternal end (where the ribs meet).

4. Where is pressure applied to the chest during closed cardiac massage? The point of maximum pressure should be in the center, not on the left, because the heart, contrary to popular belief, is located in the middle.

5. The thumb should be facing the person’s chin or stomach. The second palm is placed crosswise on top. The fingers should not touch the patient; the palm should be placed with the base and be extended as much as possible.

6. Pressure on the heart area is done with straight arms, the elbows do not bend. Pressure should be applied with your entire weight, not just your hands. The shocks should be so strong that the chest of an adult falls by 5 centimeters.

7. With what frequency of pressure is indirect cardiac massage performed? Press on the sternum at least 60 times per minute. You need to focus on the elasticity of the sternum of a particular person, precisely on how it returns to its opposite position. For example, in an elderly person the frequency of clicks may be no more than 40–50, and in children it can reach 120 or higher.

8. How many breaths and presses should you take during artificial respiration?

Every 15 compressions assisting blows air into the victim's lungs twice in a row and again performs a heart massage.

Why is indirect cardiac massage impossible if the victim is lying on something soft? In this case, the pressure will be released not on the heart, but on the pliable surface.

Age of the victim	How to press	Pressing point	Depth of pressing	Velocity	Inhalation/pressure ratio
Age up to 1 year	2 fingers	1 finger below the nipple line	1.5–2 cm	120 and more	2/15
Ages 1–8 years	1 hand	2 fingers from the sternum	3–4 cm	100–120	2/15
Adult	2 hands	2 fingers from the sternum	5–6 cm	60–100	2/30

Artificial respiration "mouth to mouth"

If a poisoned person has secretions in the mouth that are dangerous for the resuscitator, such as poison, poisonous gas from the lungs, or an infection, then artificial respiration is not necessary! In this case, you need to limit yourself to performing an indirect cardiac massage, during which, due to pressure on the sternum, about 500 ml of air is expelled and again absorbed.

How to do mouth-to-mouth artificial respiration?

Artificial respiration from mouth to nose

Artificial respiration “mouth to nose” is performed if the patient is unable to open his mouth (for example, due to a spasm).

Having laid the victim on a straight surface, tilt his head back (if there are no contraindications for this).
Check the patency of the nasal passages.
If possible, the jaw should be extended.
After a maximum inhalation, you need to blow air into the injured person’s nose, tightly covering his mouth with one hand.
After one breath, count to 4 and take the next one.

Features of resuscitation in children

How to determine if resuscitation is being performed correctly

Signs of effectiveness when following the rules for performing artificial respiration are as follows.

When artificial respiration is performed correctly, you may notice the chest moving up and down during passive inspiration.
If the movement of the chest is weak or delayed, you need to understand the reasons. Probably a loose fit of the mouth to the mouth or nose, a shallow breath, a foreign body preventing the air from reaching the lungs.
If, when you inhale air, it is not the chest that rises, but the stomach, then this means that the air did not go through the airways, but through the esophagus. In this case, you need to press on the stomach and turn the patient's head to the side, as vomiting is possible.

The effectiveness of cardiac massage also needs to be checked every minute.

If, when performing an indirect cardiac massage, a push appears on the carotid artery, similar to a pulse, then the pressing force is sufficient for blood to flow to the brain.
If resuscitation measures are performed correctly, the victim will soon experience heart contractions, blood pressure will rise, spontaneous breathing will appear, the skin will become less pale, and the pupils will narrow.

The correctness of the massage is determined by the appearance of a pulse in the carotid artery in time with pressing on the chest.

Heart massage: types, indications, closed (indirect) with mechanical ventilation, rules

It often happens that a random passerby on the street may need help on which his life depends. In this regard, any person, even if he does not have a medical education, must know and be able to correctly and competently, and most importantly, immediately, provide assistance to any victim.
That is why training in the methods of such activities as indirect cardiac massage and artificial respiration begins at school during life safety lessons.

Cardiac massage is a mechanical effect on the heart muscle in order to maintain blood flow through the large vessels of the body at the time of cardiac arrest caused by a particular disease.

Heart massage can be direct or indirect:

Direct massage is carried out only in the operating room, during heart surgery with an open chest cavity, and is carried out through squeezing movements of the surgeon’s hand.

Execution technique indirect (closed, external) heart massage anyone can master it, and it is carried out in combination with artificial respiration. (T.n.z.).

However, according to the current legislation of the Russian Federation, a person providing emergency care (hereinafter referred to as a resuscitator) has the right not to perform artificial respiration using the mouth-to-mouth or mouth-to-nose method in cases where there is a direct or hidden threat to his health. So, for example, in the case when the victim has blood on his face and lips, the resuscitator may not touch him with his lips, since the patient may be infected with HIV or viral hepatitis. An antisocial patient, for example, may turn out to be a patient with tuberculosis. Due to the fact that it is impossible to predict the presence of dangerous infections in a particular unconscious patient, artificial respiration may not be performed until emergency medical assistance arrives, and assistance to a patient with cardiac arrest is provided through chest compressions. Sometimes in specialized courses they teach that if the resuscitator has a plastic bag or napkin, you can use them. But in practice, we can say that neither a bag (with a hole for the victim’s mouth), nor a napkin, nor a medical disposable mask purchased at a pharmacy protect against a real threat of transmission of infection, since contact of mucous membranes through the bag or wet (from breathing) resuscitator) the mask still happens. Contact of mucous membranes is a direct route of transmission of the virus. Therefore, no matter how much the resuscitator wants to save the life of another person, one should not forget about one’s own safety at this moment.

After doctors arrive at the scene, artificial pulmonary ventilation (ALV) begins, but with the help of an endotracheal tube and an Ambu bag.

Algorithm for external cardiac massage

So, what to do before the ambulance arrives if you see an unconscious person?

Firstly, do not panic and try to correctly assess the situation. If a person has just fallen in front of you, or has been injured, or has been pulled out of the water, etc., the need for intervention should be assessed, since indirect cardiac massage is effective in the first 3-10 minutes from the onset of cardiac arrest and breathing. If a person has not been breathing for a long time (more than 10-15 minutes) according to the people nearby, resuscitation can be performed, but most likely it will be ineffective. In addition, it is necessary to assess the presence of a threatening situation for you personally. For example, you cannot provide assistance on a busy highway, under falling beams, near an open fire during a fire, etc. Here you need to either move the patient to a safer place, or call an ambulance and wait. Of course, the first option is preferable, since minutes count for someone else’s life. The exception is for victims who are suspected of having a spinal injury (diver injury, car accident, fall from a height), it is strictly forbidden to carry them without a special stretcher, however, when saving lives is at stake, this rule can be neglected. It is impossible to describe all situations, so in practice you have to act differently each time.

After you see a person unconscious, you should shout out to him loudly, lightly hit him on the cheek, in general, attract his attention. If there is no reaction, we place the patient on his back on a flat, hard surface (on the ground, floor, in the hospital we lower the recumbent gurney to the floor or transfer the patient to the floor).

NB! Artificial respiration and cardiac massage are never performed on a bed; its effectiveness will obviously be close to zero.

Next, we check the presence of breathing in a patient lying on his back, focusing on the rule of three “Ps” - “look-listen-feel.” To do this, you should press on the patient’s forehead with one hand, “lift” the lower jaw upward with the fingers of the other hand and bring the ear closer to the patient’s mouth. We look at the chest, listen to breathing and feel the exhaled air with our skin. If this is not the case, let's start.

After you have made the decision to perform cardiopulmonary resuscitation, you need to call one or two people from the environment to you. Under no circumstances do we call an ambulance ourselves—we don’t waste precious seconds. We give the command to one of the people to call the doctors.

After visually (or by touching with your fingers) an approximate division of the sternum into three thirds, we find the border between the middle and lower. According to the recommendations for complex cardiopulmonary resuscitation, this area should be struck with a fist with a swing (precordial blow). This is the technique that is practiced by medical professionals at the first stage. However, an ordinary person who has not made such a blow before can cause harm to the patient. Then, in the event of subsequent proceedings regarding broken ribs, the actions of NOT the doctor may be regarded as an abuse of authority. But in the case of successful resuscitation and broken ribs, or when the resuscitator does not exceed his authority, the outcome of the court case (if one is initiated) will always be in his favor.

start of cardiac massage

Then, to begin a closed cardiac massage, the resuscitator, with clasped hands, begins to perform rocking, pressing movements (compressions) on the lower third of the sternum with a frequency of 2 presses per second (this is a fairly fast pace).

We fold our hands into a lock, while the leading hand (right for right-handers, left for left-handers) wraps its fingers around the other hand. Previously, resuscitation was carried out simply by putting hands on top of each other, without grip. The effectiveness of such resuscitation is much lower; now this technique is not used. Only hands interlocked.

hand position during cardiac massage

After 30 compressions, the resuscitator (or a second person) exhales two times into the victim’s mouth, while closing his nostrils with his fingers. At the moment of inhalation, the resuscitator should straighten up to inhale completely, and at the moment of exhalation, bend over the victim again. Resuscitation is carried out in a kneeling position next to the victim. It is necessary to perform indirect cardiac massage and artificial respiration until cardiac activity and breathing resume, or in the absence of such, until rescuers arrive who can provide more effective mechanical ventilation, or within 30-40 minutes. After this time, there is no hope for restoration of the cerebral cortex, since biological death usually occurs.

The real effectiveness of chest compressions consists of the following facts:

According to statistics, successful resuscitation and complete restoration of vital functions in 95% of victims is observed if the heart was able to “start” in the first three to four minutes. If a person was without breathing and heartbeat for about 10 minutes, but resuscitation was still successful, and the person began to breathe on his own, he will subsequently survive resuscitation illness, and, most likely, will remain deeply disabled with an almost completely paralyzed body and a violation of higher nervous activity. Of course, the effectiveness of resuscitation depends not only on the speed of performing the described manipulations, but also on the type of injury or disease that led to it. However, if chest compressions are necessary, first aid should be started as soon as possible.

Video: performing chest compressions and mechanical ventilation

Once again about the correct algorithm

Unconscious person → “Are you feeling bad? Can you hear me? Do you need help? → No response → Turn over onto your back, lay on the floor → Pull out the lower jaw, look, listen, feel → No breathing → Note the time, start resuscitation, instruct a second person to call an ambulance → Precordial blow → 30 compressions on the lower third of the sternum/2 exhale into the victim’s mouth → After two to three minutes, assess the presence of respiratory movements → No breathing → Continue resuscitation until doctors arrive or within thirty minutes.

What can and cannot be done if resuscitation is necessary?

According to the legal aspects of first aid, you have every right to assist an unconscious person, since he cannot give his consent or refuse. Regarding children, it is a little more complicated - if the child is alone, without adults or without official representatives (guardians, parents), then you are obliged to start resuscitation. If the child is with parents who actively protest and do not allow touching the unconscious child, all that remains is to call an ambulance and wait for the rescuers to arrive on the sidelines.

It is strictly not recommended to provide assistance to a person if there is a threat to your own life, including if the patient has open, bloody wounds and you do not have gloves. In such cases, everyone decides for themselves what is more important to them - to protect themselves or to try to save the life of another.

Do not leave the scene if you see a person unconscious or in serious condition– this will be qualified as leaving in danger. Therefore, if you are afraid to touch a person who may be dangerous to you, you must at least call him an ambulance.

Video: presentation on cardiac massage and mechanical ventilation by the Ministry of Health of the Russian Federation

In various accidents, when the victim has no breathing and no signs of heart contraction, it is necessary to begin artificial ventilation of the lungs and closed heart massage as soon as possible.

Provides the introduction of fresh air (mixture) rich in oxygen into the lungs and the removal from the lungs of air poor in oxygen and rich in carbon dioxide. Thanks to artificial ventilation of the lungs, the body is saturated with oxygen and gets rid of carbon dioxide, i.e., the conditions necessary for their life are maintained in the tissues. The cells of the cerebral cortex are especially sensitive to a decrease in oxygen content in the body.

Thus, in the absence of blood circulation during a person’s orgasm (cardiac arrest) for more than 4-5 minutes, irreversible changes begin to develop in brain cells. During this period (4−5 minutes) of the so-called clinical death, slow metabolic processes still remain in the body, which allows a person to return to life. This circumstance explains the effectiveness of artificial respiration and closed cardiac massage in the first minutes after the victim stops breathing and contracts the heart.

Pronounced pallor of the skin, blueness of the lips, nails, lack of respiratory movements of the chest and abdomen convincingly indicate cessation of breathing, and sometimes heartbeat.

In an unconscious state, the victim’s facial muscles relax, and the tongue often sinks to the back wall of the pharynx, thereby blocking the airways (larynx, trachea). Therefore, before starting artificial respiration, it is necessary to restore the patient’s airway.

The most effective methods of artificial respiration are to blow air from the mouth of the person providing assistance into the mouth or nose of the victim.

These methods are called:

a) “mouth to mouth”

b) “mouth to nose”

They are carried out as follows:

1. free the victim from diving equipment and compressive clothing, lay him on his back, place rolled clothing under his shoulders in the form of a cushion;

2. the person providing assistance usually stands on the side of the victim’s head;

3. check the oral cavity and pharynx: if there is silt, sand, clots of mucus and blood, remove all contents. To do this, you need to turn your head and shoulders to the side, open your mouth and use your index finger wrapped in a napkin (handkerchief) to remove everything;

4. ensure sufficient airway patency, depending mainly on the position of the head.

The head should be thrown back to the limit, only in this position the root of the tongue moves away from the back wall of the pharynx and opens the airways. To bend the head back, you need to place one hand under the victim’s neck, and with the other press on the forehead until the head is thrown back to the limit. If, with this position of the head, the tongue is still in a sunken position, it must be pulled out with your hand or a tongue holder, after placing a gauze napkin on it.

5. The person providing assistance takes a deep breath and then, pressing his mouth tightly against the victim’s mouth or nose (this can be done through gauze or a handkerchief), exhales. At the moment of blowing air into the victim’s mouth, the nose should be clamped with the fingers of the free hand, and when air is blown into the nose, the victim’s mouth should be tightly closed.

The person providing assistance then leans back and takes another breath. During this period, the victim’s chest descends and passive exhalation occurs. Insufflation should be carried out 12-16 times per minute. If artificial respiration is carried out correctly, then the chest rises when air is blown in and the pallor of the mucous membranes and skin decreases. If this does not happen, you need to check the airway and achieve a good seal when blowing air into the victim’s lungs.

To facilitate artificial respiration using the mouth-to-mouth method, special rubber or plastic S-shaped tubes can be used. Such a tube is inserted into the mouth, pharynx (to the root of the tongue) and through it air is blown into the victim’s lungs. This device eliminates unpleasant aspects of an aesthetic and hygienic nature, but unfortunately does not allow for complete sealing, and this reduces the effectiveness of blowing air into the victim’s lungs.

During artificial respiration, it is necessary to monitor the presence of a pulse - if the pulse is not palpable, heart contractions are not heard and the pupils are dilated, then this indicates that the heart has stopped working. The task of the person providing assistance is complicated by the fact that, along with artificial ventilation, urgent measures must be taken to restore blood circulation. Because only with a combination of active ventilation of the lungs and blood circulation do the body’s cells receive the required amount of oxygen, and their vital functions are restored.

The most accessible way to maintain blood circulation in the body when the heart stops is closed cardiac massage.

It consists in the fact that by pressing on the sternum, the chest moves closer to the spine, while the heart is compressed, its chambers are compressed and blood is expelled from them into their normal vessels. When the pressure on the sternum ceases, the chest returns to its previous position, the cavities of the heart expand and are filled with new portions of venous blood. Thus, when an external influence is applied to the heart, it again performs its normal pump function. Blood circulation in the body and especially in the heart itself is restored, and this leads to its active independent activity.

The technique of closed cardiac massage consists of the following stages:

1. Free the victim from restrictive clothing and place him on his back, on a hard surface;

2. The head should be thrown back, i.e. in a position suitable for artificial ventilation of the lungs;

3. The person performing the massage is located on the side of the victim;

4. The palm of one hand is placed on the lower half of the sternum slightly to the left, and the hand of the second hand is placed across the first to increase pressure;

5. Pressure on the sternum should be done with quick rhythmic pushes (60-80 times per minute) with straightened arms, mainly due to your weight;

6. The pressure must be strong enough to move the chest by 3-4 cm. If the hands are positioned incorrectly, damage to the ribs, sternum and some internal organs may occur during the period of pressure;

7. After each pressure, the hands quickly relax and the chest returns to its original position.

Changes in the color of the mucous membranes and skin and the presence of a pulse in large vessels, as well as constriction of the pupils, indicate the effectiveness of closed heart massage.

Artificial respiration and closed cardiac massage can be performed by one person, but it is better to do it together. In this case, after three artificial insufflations, you should alternate 12-16 rhythmic pressures on the sternum or after 4-5 pressures, do one insufflation. Quite satisfactory blood circulation can be maintained for a relatively long time (1−1.5 hours) if the massage is performed correctly.

Artificial respiration and closed cardiac massage should be carried out until spontaneous breathing and heartbeat are restored or until signs of death appear that can only be identified by a medical professional.